Prescription of analgesia in emergency medicine (POEM) secondary analysis: an observational multicentre comparison of pain relief provided to adults and children with an isolated limb fracture and/or dislocation

Abstract

BackgroundAcute pain is a common reason for emergency department (ED) attendance. Royal College of Emergency Medicine (RCEM) pain management audits have shown national variation and room for improvement. Previous evidence suggests that children receive less satisfactory pain management than adults.MethodsPrescription of analgesia in emergency medicine is a cross-sectional observational study of consecutive patients presenting to 12 National Health Service EDs with an isolated long bone fracture and/or dislocation, and was carried out between 2015 and 2017. Using the recommendations in the RCEM Best Practice Guidelines, pain management in ED was assessed for differences of age (adults vs children) and hospital type (children’s vs all patients).ResultsFrom the total 8346 patients, 38% were children (median age 8 years). There was better adherence to the RCEM guidance for children than adults (24% (766/3196) vs 11% (579/5123)) for the combined outcome of timely assessment, pain score and appropriate analgesia. In addition, children were significantly more likely than adults to receive analgesia appropriate to the pain score (of those with a recorded pain score 67% (1168/1744) vs 52% (1238/2361)). Children’s hospitals performed much better across all reported outcomes compared with general hospitals.ConclusionsIn contrast to previous studies, children with a limb fracture/dislocation are more likely than adults to have a pain score documented and to receive appropriate analgesia. Unexpectedly, children’s EDs performed better than general EDs in relation to timely and appropriate analgesia but the reasons for this are not apparent from the present study.

Early Opiate Analgesic Requirements Following Nonsurgically Managed Tibial Fractures in Children

“…While significant attention has been given to the immediate management of pain prehospital and in the emergency department (ED), there is limited analysis of analgesic requirements in the first days following this injury. [7][8][9][10] The standard practice at our institution is to admit children with tibial shaft fractures that are to be managed nonsurgically from the ED for limb elevation and observation for compartment syndrome. This has included children who have had a successful fracture reduction and application of cast following a standardized ED analgesia protocol.…”

“…In addition to monitoring for compartment syndrome, admitted children are provided regular and breakthrough analgesics for pain control. While significant attention has been given to the immediate management of pain prehospital and in the emergency department (ED), there is limited analysis of analgesic requirements in the first days following this injury 7–10…”